Liver Fat and Its Association with Time to Biochemical Failure (TTBCF) after Definitive Treatment to the Prostate

PURPOSE/OBJECTIVE(S)

Elevated body mass index (BMI) is associated with an increased risk of biochemical failure (BCF); however, BMI may not best capture underlying health. We examined a different metric, liver fat, which may better approximate the body's metabolic state, to see its association with time to biochemical failure (TTBCF) in patients treated definitively for prostate cancer.

MATERIALS/METHODS

Of 210 patients who received a PSMA PET/CT at our institution, we identified 60 men treated with either prostatectomy or definitive radiation without androgen deprivation therapy who developed BCF. BCF was defined as PSA ≥ 0.2 ng/mL if treated with prostatectomy or PSA nadir + 2 ng/mL for those treated with definitive radiation. All prostatectomy patients had a post-op PSA < 0.1. Liver fat was evaluated via the non-contrast portion of respective PSMA PET/CT scans. Average Hounsfield Units (HU) of the liver were used to split individuals into high (≤ 56.1) and low (> 56.1) liver fat. A threshold of 56.1 HU was chosen as it corresponds to 5.56% liver fat, or the 95th percentile of non-obese, non-diabetic controls. Liver fat was quantified by converting HU to proton density fat fraction (PDFF) using the formula: PDFF = -0.582*HU + 38.214. Median TTBCF was estimated using Kaplan Meier methods, and Cox Proportional Hazards Regression was used for covariate adjustment.

RESULTS

Forty-four patients were classified as having high liver fat (HLF) and 16 as having low liver fat (LLF). Patients with HLF were more likely to have a higher BMI, have high risk disease, undergo surgery, and have shorter TTBCF (Table). When adjusted for NCCN risk category and treatment type, HLF was associated with twice the risk of BCF per unit time (aHR = 2.02, 95% CI [1.09 - 3.73], p = 0.03). With additional adjustment for BMI (continuous), HLF was no longer an independent predictor of TTBCF (aHR = 1.75, 95% CI [0.94 - 3.25], p = 0.08).

CONCLUSION

In this small study of patients who had biochemical failure after completing definitive treatment to the prostate, those with liver fat ≥ 5.56% were more likely to fail sooner, adjusting for risk category and treatment type. This project suggests that a man with elevated liver fat, on average, experiences a shorter interval free from prostate cancer.

Is it necessary to perform week three dosimetric analysis in low-dose-rate brachytherapy for prostate cancer when day 0 dosimetry is done? A quality assurance assessment

PURPOSE

To determine whether computed tomography/magnetic resonance imaging-based day 0 (d0) dosimetry is a meaningful predictor of day 21 (d21) dosimetry in low-dose-rate brachytherapy for localized prostate cancer.

METHODS AND MATERIALS

The study population consisted of 277 men with localized (T1-2 N0 M0), low-/intermediate-risk prostate cancer treated with low-dose-rate brachytherapy. Computed tomography/magnetic resonance imaging fusion was used for postimplant dosimetry at d0 and d21. Logistic regression was used to construct receiver operating characteristic curves for achieving each constraint at d21, based on d0 D90 and V100, and Youden's index was used to evaluate cutpoints. Freedom from biochemical failure (FBCF) was estimated with the Kaplan-Meier method.

RESULTS

The median d0 D90 increased from 133 to 150 Gy at d21, and median d0 V100 increased from 87% to 91%. For achieving the D90 constraint at d21, the optimal cut-point for d0 D90 was 135 Gy, with 84% of these patients maintaining a d21 D90 > 145 Gy. For achieving the D90 constraint at d21, the optimal cut-point for d0 V100 was 87%, with 83% of these patients maintained a d21 V100 > 90%. There was no improvement in FBCF in patients with a d0 D90 > 135 Gy or D90 > 145 Gy. Similarly, there was no improvement in FBCF in patients with a d0 V100 > 87% or V100 > 90%.

CONCLUSIONS

Meeting dosimetric constraints on d0 does not obviate d21 dosimetric analysis. Constraints used for dose prescriptions on d0 are not the ideal predictors of d21 dosimetry.

Genetic counselors' (GC) knowledge, awareness, understanding of clinical next-generation sequencing (NGS) genomic testing

Genomic tests are increasingly complex, less expensive, and more widely available with the advent of next-generation sequencing (NGS). We assessed knowledge and perceptions among genetic counselors pertaining to NGS genomic testing via an online survey. Associations between selected characteristics and perceptions were examined. Recent education on NGS testing was common, but practical experience limited. Perceived understanding of clinical NGS was modest, specifically concerning tumor testing. Greater perceived understanding of clinical NGS testing correlated with more time spent in cancer-related counseling, exposure to NGS testing, and NGS-focused education. Substantial disagreement about the role of counseling for tumor-based testing was seen. Finally, a majority of counselors agreed with the need for more education about clinical NGS testing, supporting this approach to optimizing implementation.

Abstract P2-12-05: Exploring the experience of relatives with whom genetic test results are communicated

There is increasing interest in the psychosocial impact of genetic testing, both on the individual who has been tested and on family members who could benefit from knowing the test results. The responsibility for informing relatives of genetic test results falls on the proband, the first family member being tested. While there is limited data about the reaction of relatives with whom genetic test results are shared, there is some evidence that open, positive family relationships increase the likelihood of disclosure of test results while emotional distance, family conflict, and loss of contact decrease the likelihood of disclosure. We explored the communication process between probands undergoing genetic testing for BRCA1/2 and their first degree relatives with whom they shared results. Four hundred twenty two women were randomized to a communication skills-building intervention or a wellness control session. Overall, probands shared their test result with 80% of eligible relatives. As part of this study, relatives were surveyed by phone regarding factors associated with the communication process, and their ability to understand and cope with the information provided to them by the proband. This study focuses on 438 relatives (of 253 probands) who reported that test results were shared. The percent of relatives with whom genetic test results were shared did not differ by study group. However, there were significant differences across gender and generation. Female relatives were more likely to receive genetic test results (p = 0.0001), and adult children were more likely to receive genetic test results than either parents or siblings (p = 0.0006). Both positive and true negative test results were more likely to be communicated to relatives than indeterminate or inconclusive results. Comparing the actual test result of the proband with that reported by the relative, we found that 26% of relatives cited an incorrect test result, and this number did not differ by study group. Positive test results were the most likely to be correctly understood by the relatives (90%), while inconclusive test results were the least likely to be correctly understood (60%) (p = 0.005). When asked about their reaction to receipt of test results, 32% of relatives reported difficulty in understanding the test result, and 27% were upset with the information they received. Of those relatives whose proband received a positive test result, only 52% reported intention to pursue testing for themselves. Similarly, only 36% of relatives whose proband received true negative test results intended to pursue testing, implying the relatives did not fully understand the significance of these informative results for their own risk These findings indicate that sharing of genetic test results by probands to their adult first degree relatives is variable, that the information shared is often not well understood, and that there is significant distress associated with the sharing of test results on the part of the relatives. These findings suggest that relying on the probands to share their test results with their relatives is fraught with limitations which may compromise the value of the information for the relatives.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-05.

Genetic variation in IL-16 miRNA target site and time to prostate cancer diagnosis in African-American men

BACKGROUND

Men with a family history of prostate cancer and African-American men are at high risk for prostate cancer and in need of personalized risk estimates to inform screening decisions. This study evaluated genetic variants in genes encoding microRNA (miRNA) binding sites for informing of time to prostate cancer diagnosis among ethnically diverse, high-risk men undergoing prostate cancer screening.

METHODS

The Prostate Cancer Risk Assessment Program (PRAP) is a longitudinal screening program for high-risk men. The eligibility includes men aged between 35 and 69 years with a family history of prostate cancer or African descent. Participants with 1 follow-up visit were included in the analyses (n=477). Genetic variants in genes encoding miRNA binding sites (ALOX15 (arachidonate 15-lipooxygenase), IL-16, IL-18 and RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1)) previously implicated in prostate cancer development were evaluated. Genotyping methods included Taqman SNP Genotyping Assay or pyrosequencing. Cox models were used to assess time to prostate cancer diagnosis by risk genotype.

RESULTS

Among 256 African Americans with one follow-up visit, the TT genotype at rs1131445 in IL-16 was significantly associated with earlier time to prostate cancer diagnosis vs the CC/CT genotypes (P=0.013), with a suggestive association after correction for false discovery (P=0.065). Hazard ratio after controlling for age and PSA for TT vs CC/CT among African Americans was 3.0 (95% confidence interval: 1.26-7.12). No association with time to diagnosis was detected among Caucasians by IL-16 genotype. No association with time to prostate cancer diagnosis was found for the other miRNA target genotypes.

CONCLUSIONS

Genetic variation in IL-16 encoding miRNA target site may be informative of time to prostate cancer diagnosis among African-American men enrolled in prostate cancer risk assessment, which may inform individualized prostate cancer screening strategies in the future.

Abstract P1-01-16: Intraoperatively-palpable “non-sentinel” nodes: should they be removed?

Background: Sentinel lymphadenectomy is the standard of care for evaluation of the axilla in breast cancer. Not infrequently, despite a clinically negative axilla, axillary nodes are found and removed that are only palpable intraoperatively at the time of sentinel lymph node biopsy. There is limited data suggesting that their resection is beneficial, and there is some controversy over whether these non-hot, non-blue nodes should also be called “sentinel nodes” (SNs).

Methods: A retrospective chart review was conducted of breast cancer patients who underwent sentinel lymph node biopsy from 2007 to 2011 at a single institution. Patients were only included if they had SNs removed (defined as blue and/or radioactive nodes), as well as additional non-sentinel nodes that were only palpable intraoperatively (pNSNs) and not part of an axillary dissection (ALND). Pathology of both SNs and pNSNs were reviewed. Histologic nodal evaluation was performed by H&E alone.

Results: From 2007 to 2011, a total of 59 patients had both SNs and pNSNs removed. Fifty-five patients (93.2%) were female and the average age was 55 years old. Fifty-two patients (88.1%) had invasive ductal carcinoma while 7 had lobular carcinoma (11.9%). Average tumor size was 2.0 cm. Among the 59 patients, a total of 109 SNs (mean 1.8, median 1, range 1–6) and 202 pNSNs (mean 3.4, median 2, range 1–30) were removed at the same surgery. Twenty patients (33.9%) had metastases in either the SNs and/or pNSNs with 16 (80.0%) of these having metastases in the SNs alone. Sixteen patients proceeded to an ALND. There were 4 patients (6.8%, 95% CI 1.9–16.5%) who had SNs negative for tumor but pNSNs positive for tumor, and 4 (6.8%, 95% CI 1.9–16.5%) separate patients who had extracapsular extension (ECE) in their pNSNs but no ECE in the SNs. The pNSNs thus provided information altering operative treatment by American College of Surgeons Oncology Group (ACOSOG) Z0011 trial criteria in 8 patients (13.6%). Two patients (3.4%, 95% CI 0.4–11.7%) had ECE present in ALND nodes, but not present in either their SNs or pNSNs.

Conclusion: pNSNs provide information that changes the surgical plan by ACOSOG Z0011 criteria in 14% of cases. Whether their removal changes patient outcomes remains unclear, especially as SNs and pNSNs may, together, be falsely-negative for ECE present within the axilla. While we recommend their removal at this time based upon the added information they provide, further study is required to determine whether the changes resulting from pNSN dissection (i.e. need for ALND) provide any outcome benefit in this era of effective systemic therapy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-16.

P5-12-05: (In-)Efficiencies in the Preoperative Imaging Evaluation of the Medicare Breast Cancer Patient

Introduction: Breast cancer evaluation requires a combination of physical examination and imaging for preoperative diagnosis and assessment of surgical treatment options. While imaging remains a critical component of that assessment, the burden of patient (pt) return visits for imaging is unknown.

Methods: Medicare claims linked to Surveillance Epidemiology End Results data were reviewed for women developing breast cancer between 1992 and 2005. The preoperative interval was defined as the period from the first physician encounter for a breast-related diagnosis until therapeutic surgery. Pts without ≥6 mos of data prior to that interval, those having DCIS or Stage IV disease, and those having preoperative chemotherapy or radiotherapy were excluded. Imaging modality counts exclude image-guidance claims for biopsies.

Results: Among 353,265 Medicare pts developing breast cancer between 1992 and 2005, 67,751 women &gt;65 y of age had invasive, nonmetastatic breast cancer, and simultaneous breast surgery (lumpectomy or mastectomy) with lymph node staging. Median age was 75 y and preoperative interval length was 27 d. In the 6 mos before the preoperative interval, mammograms (MMGs), breast ultrasounds (USs), and breast MRIs were performed exclusive of the preoperative interval in 34,192 (50.5%), 16,936 (25.0%), and 180 (0.3%) pts respectively, while during the preoperative interval, MMGs, USs, and MRIs were performed in an additional 30,414 (44.9%), 17,983 (26.5%), and 1,409 (2.1%) respective pts. Imaging was performed on ≥2 separate dates during the preoperative interval in 4.9% of pts in 1992, rising to 19.4% in 2005 (trend, p&lt;0.0001). During that interval, there were ≥2 encounter dates for MMGs in 7.0% of pts, rising from 3.9% in 1992 to 8.8% in 2005 (trend, p&lt;0.0001); for US, 3.6% overall, rising from 0.2% in 1992 to 6.6% in 2005 (trend, p&lt;0.0001). Multiple MRI encounters were rare, occurring in 0.2% overall, and increasing to 0.6% in 2005 (trend, p&lt;0.0001), while single MRI use increased from &lt;0.1% in 1994 to 8.3% in 2005 (trend, p&lt;0.0001). In the preoperative interval, use of more than one imaging modality on any given date increased from 4.3% in 1992, to 27.1% in 2005. Among those with imaging, there was low correlation between number of imaging dates and number of modalities on any given date (rs= 0.13, p&lt;0.0001). MMGs accounted for 71.9% of the days where one modality was performed alone, but MRI was performed alone 94.1% of the time. The total number of imaging dates in the preoperative interval was inversely related to age (p&lt;0.0001). Differences in the mean number of imaging dates by race and stage were minor and all &lt;0.3 days.

Conclusion: Preoperative Medicare breast imaging claims on multiple dates have been increasing substantially since 1992, suggesting that the patient's time burden for such evaluation is increasing. This trend is present despite the fact that multiple imaging modalities are being performed more frequently on the same date. Efforts to further consolidate preoperative breast imaging visits to lower that burden should be undertaken where possible in the Medicare population, for whom advanced age, in itself, may provide its own challenges.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-12-05.

Abstract P1-14-05: Predicting Brain Metastasis in Breast Cancer Patients: Who Is at Highest Risk?

Background: The development of brain metastases (BrM) in women with breast cancer is associated with more advanced stage at presentation (Atahan 2008), although predicting who is at greatest risk remains difficult. This study aims to determine the characteristics of those at highest risk for BrM, and characterize treatment prior to their development. Methods: A prospective database containing 4,169 breast cancer patients (pts) was retrospectively reviewed for those developing BrM between 1997 and 2007. Demographic and prognostic variables were reviewed. Controls without BrM were matched for T stage, N stage and ER status, with 2 matched controls for 44 BrM pts.

Results: Forty-nine patients (1.2%) developed BrM, among whom 6 were evident at initial presentation. BrM pts overall were diagnosed at a median age of 57 y with pathologic stages I and II accounting for 33% of cases at initial presentation. Pts developed BrM at a median of 19.7 mos after diagnosis. T1/T2 tumors were present in 65% of overall cases. 21 (43%) were ER/PR negative. Among 24 sites of distant disease evident prior to BrM were 16 (66%) bone and 6 (25%) lung metastases. Univariate BrM predictors included evidence of prior non-brain metastases (p=0.0004), high nuclear grade (p=0.002), PR-negativity (p=0.005), and inflammatory breast cancer (IBC, p=0.04). Family history of breast cancer approached significance (p=0.053). On multivariable analysis for predictors, prior non-brain metastases (p=0.001), high nuclear grade (p=0.006), and IBC (p=0.01) remained significant predictors. Despite adjustment for T and N stage, univariate treatments associated with, but given prior to BrM development, were use of radiotherapy (p=0.002), chemotherapy (p=0.009), and mastectomy (vs lumpectomy, p=0.03; vs no operation, p=0.0016). The sole treatment associated on multivariable analysis was chemotherapy use (p=0.02). After BrM diagnosis, 94% had whole brain radiotherapy, 22% had chemotherapy, and 8% underwent neurosurgery. BrM pts’ median survival was 38.6 mos, while matched controls did not reach median survival in 100 mos of mean follow up. Median time from BrM diagnosis to death was 10.8 mos, with a 5 y survival of 25.6%. Conclusion: The development of BrM is associated with shorter survival in patients with breast cancer. Several clinico-pathologic factors may identify patients at greatest risk of developing BrM, even in the face of more aggressive primary therapy. Such risk factors should be considered when developing early diagnostic and therapeutic interventions for BrM, and when validating any such intervention prospectively.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-14-05.

Phase II study of pemetrexed (P) and gemcitabine (G) in patients with advanced head and neck cancer (SCCHN)

6052

Background: Unresectable/metastatic squamous cell cancer of the head and neck (SCCHN) has a poor prognosis despite standard therapy with cisplatin. Given the substantial toxicities of cisplatin and its widespread use in combination with RT in LA- SCCHN, we investigated an alternative regimen of gemcitabine (G) and pemetrexed (P). A phase II study of pemetrexed in SCCHN had a response rate (RR) of 26.5%. A phase I study of the P and G combination showed the doses and schedule below to be feasible. Methods: Eligibility stipulated measurable, incurable, unresectable recurrent/metastatic SCCHN; Karnofsky PS of > 60%, and adequate bone marrow, renal and hepatic function. One prior therapy for recurrent disease was allowed. Patients were treated with P 500 mg/m2 and G 1,500 mg/m2 every 2 weeks. Each cycle was 28 days. Primary endpoint was RR. Secondary endpoints included overall survival and toxicity. Patients were re-imaged every 2 cycles. In a 2-step design, 16 patients were to be accrued during stage 1, and 16 were projected for stage 2. If 1 or fewer responses were observed during the first stage, then the trial was to be stopped and the regimen deemed insufficiently active. Results: 17 patients were enrolled in stage 1. Median age was 64 years (range, 49–82); 10 males; 13 smokers (including 4 current smokers). 15 patients previously received definitive therapy with surgery and/or chemo-RT, and 9 had prior systemic therapy for recurrent/metastatic disease. Median number of cycles administered was 2 (range, <1 to 10). Reasons for treatment discontinuation included progressive disease in 15 patients and decreased PS in 1. Grade 3 toxicities included neutropenia (1), anemia (3), thrombocytopenia (1), dysphagia (11), fatigue (4), hypertension (4), and hyperglycemia (4). 1 pt had grade 4 anemia. Best response: 1 confirmed PR, 1 unconfirmed PR, 3 SD, 10 PD, 2 not evaluable. 7 patients received subsequent treatment. Estimated median overall survival is 5.5 months. Conclusions: The combination of P and G for advanced HNSCC was well tolerated, but its clinical efficacy was marginal in an unselected population. Due to early stopping rules, the study was closed to accrual after stage 1 for lack of efficacy. Further study of this regimen should be considered in patients enriched for TS and RRM1 status.

[Table: see text]

Met160Val TMPRSS2 gene polymorphism and early onset prostate cancer in high-risk men

5000

Background: The TMPRSS2-ERG gene fusion has been found in over 50% of prostate tumors and its role is being characterized in various clinical settings. The T-allele of the Met160Val single nucleotide polymorphism (SNP) has been found to be associated with translocation and multiple copies of the TMPRSS2-ERG fusion. This SNP needs clinical characterization in men at high risk for prostate cancer (PCA) (men with a family history [FH] of PCA and African American [AA] men) to determine the role in personalizing PCA early detection. The Prostate Cancer Risk Assessment Program (PRAP) is a prospective screening program for high risk men. PRAP has > 700 participants, and 60% are AA. Here we evaluated the Met160Val SNP (rs12329760) in the TMPRSS2 gene with respect to race, FH of PCA, and time to PCA diagnosis. Methods: Eligibility for PRAP includes men ages 35–69 years with one first degree relative with PCA, two second degree relatives with PCA on the same side of the family, any AA man regardless of FH of PCA, and men with BRCA1/2 mutations. Criteria for biopsy and biopsy approach have been reported previously. Genotyping of the Met160Val SNP was performed using the Taqman SNP Genotyping Assay (Applied Biosystems). Standard statistical methods were used to determine risk-genotype distributions. Cox models were used for time to PCA diagnosis by risk genotype. Results: Out of 700 men in PRAP, 631 were able to be genotyped for the Met160Val SNP. There was no difference in distribution of genotypes (CT/TT vs. CC) among 231 White men with familial PCA and 400 AA men in PRAP. Among 183 White men with familial PCA with > one follow-up visit, those with the CT/TT genotypes were found to have a significantly earlier time to PCA diagnosis vs. the CC genotype (p = 0.0058). In addition, the hazard ratio for PCA among high-risk White men of the CT/TT genotypes vs CC genotype was 2.55 (p = 0.022) after controlling for age and PSA. No trends were seen among AA men for time to PCA diagnosis for any of the Met160Val SNP genotypes. Conclusions: The T-allele of the Met160Val variant in the TMPRSS2 gene may be informative of time to PCA diagnosis among White men who have a FH of PCA. This genetic variant warrants further study in high-risk men with familial PCA for its role in personalizing PCA early detection.

No significant financial relationships to disclose.

Phase II study of weekly docetaxel and gemcitabine in relapsed patients (pts) with advanced, platinum-exposed non-small cell lung cancer (NSCLC)

18039

Background: Docetaxel (D) has, clear-cut therapeutic superiority compared to best supportive care, or ifosfamide/vinorelbine in relapsed NSCLC and, as a result, is the standard of comparison in the second line setting. In the pre-pemetrexed era, gemcitabine (G) in phase II studies also demonstrated activity in the salvage setting with favorable survival rates. We therefore mounted a phase II trial pairing these two agents in pts with progressive disease (PD) after prior platinum-based therapy. Methods: Pts with advanced NSCLC and ECOG PS 0–1 progressing either during or after prior platin-based therapy received D 40 mg/m2 days 1 and 8, in combination with G 800 mg/m2 days 1 and 8 every 3 wks. In the absence of dose limiting myelosuppression or other gr=3 toxicities, the dose of G was escalated on an intra-patient basis to 1 g/m2 days 1 and 8. Pts continued treatment until disease progression or unacceptable toxicity. Results: 35 pts were enrolled: 20 pts (57%) were male; 69% were ECOG PS 1; 57% had received prior XRT. Median age was 61 (range 30–79); median time from initial diagnosis to enrollment was 12.4 months. 170 cycles total were administered (median 4, range 1–16). Overall response rate was 23% (95% CI 12–39%). Median event free survival (EFS) was 5.7 months; median overall survival 12.5 mos; with 1 year survival rate of 51%, and 2 year survival rate 20%. Those enrolled within 12 months of initial diagnosis had poorer EFS compared to those beyond 12 months (log rank p=0.04). There were no treatment-related deaths. Typical grade = 3 toxicities included neutropenia (43%), neutropenic fever (9%) diarrhea (6%), pneumonitis (9%), LFT elevations (9%) and dermatitis (9%), including nail changes. Conclusions: Combination docetaxel and gemcitabine administered days 1 and 8 every 3 weeks in good performance NSCLC pts with PD after/during platinum-based therapy appears encouraging, and presents a viable option in this population. Proof of benefit vs. docetaxel alone requires phase III testing.

No significant financial relationships to disclose.

Variable fate of virus-specific CD4(+) T cells during primary HIV-1 infection

Impairment of CD4(+) T lymphocyte responses to human immunodeficiency virus (HIV)-derived antigens is the classic immunological defect observed during the chronic phase of HIV-1 infection. Early intervention with potent antiretroviral therapy (ART) can preserve HIV-specific CD4(+) T lymphocyte reactivity, providing indirect evidence that such responses are mounted during primary infection and subsequently lost in the majority of infected individuals. Here, we demonstrate early and dramatic expansions of functional HIV-specific CD4(+) T lymphocyte frequencies directly ex vivo. These responses are initially of broad specificity, and can disappear rapidly during the natural course of primary infection. This process of loss is variable, such that the rapidity and extent of functional compromise differs between individuals. Institution of ART during these early phases of HIV-1 infection preserves patterns of functional reactivity within the HIV-specific CD4(+) T lymphocyte population. However, there was no evidence for the restoration of deleted responses. These findings indicate that, in some individuals at least, ART must be administered within a narrow window of opportunity during primary HIV-1 infection to effect substantial immune preservation.

Blood pressure levels, related factors, and hypertension control status of Japanese and Americans

Blood pressure levels and related factors in Japanese, US whites and US blacks aged 30 to 74 years were compared, using data from the similarly designed national survey of each country in a similar period, i.e., the National Survey on Circulatory Disorders of Japan, 1980 (10,897 persons from all over Japan) and the second National Health and Nutrition Survey of the US, 1976 to 1980 (NHANES-II) (16,204 persons from all over the USA). Data collection methods were judged to be comparable. Data were stratified by age (30-39, 40-49, 50-59, 60-69, 70-74 yrs) and sex. Age-specific and age-adjusted mean systolic BPs of Japanese were generally higher than those of US whites; mean diastolic pressures were similar in the two populations in both men and women. Mean weight and body mass index (BMI) and their standard deviations were lower for Japanese than Americans. In US blacks, BP was higher than in Japanese or in US whites for diastolic in men, and for both systolic and diastolic in women. Systolic BP levels of black men were between those of Japanese and US whites. At specific levels of BMI, Japanese systolic BPs were markedly higher than those of US whites in all age-sex groups, and diastolic pressures were higher in Japanese than in US whites, slightly so at younger ages and more so at ages 60 and over in both sexes. The proportions of all persons with high BP who were receiving antihypertensive treatment and who were controlled were similar in most age-sex groups of the Japanese and US white populations; they were lower in US black men and higher in US black women. In linear regression analyses of BP on BMI controlled for age, slopes were similar for Japanese and Americans. However, given the lower mean BMI and smaller BMI standard deviation (less overweight), partial correlation coefficients between BMI and BP were smaller for Japanese than Americans. These results indicate that overweight plays a lesser role in Japanese than Americans in producing high prevalence rates of hypertension and that other factors are critically involved (e.g., intake of sodium, potassium, calcium, alcohol).

Effects on serum lipids of adding instant oats to usual American diets

This study was designed as a test of the serum lipid response and dietary adaptation to recommended daily inclusion of instant oats in an otherwise regular diet. Hypercholesterolemic adults were randomly assigned to a control or intervention group. Participants in the intervention group were given packages of instant oats and requested to eat two servings per day (approximately two ounces dry weight), substituting the oats for other carbohydrate foods in order to maintain baseline calorie intake and keep weight stable. Serum lipids were measured in blood collected by venipuncture at baseline, four weeks, and eight weeks. Baseline mean total cholesterol (TC) levels were 6.56 mmol/L and 6.39 mmol/L for intervention and control groups, respectively. After eight weeks, mean serum total cholesterol of the intervention group was lower by -0.40 mmol/L, and mean net difference in TC between the two groups was 0.32 mmol/L (95% CI: 0.09, 0.54). Low-density lipoprotein-cholesterol was similarly reduced with mean net difference of 0.25 mmol/L (95% CI: 0.02, 0.48) between the two groups. Mean soluble fiber intake increased along with slight self-imposed reductions in mean total fat, saturated fat, and dietary cholesterol intake in the intervention group. Neither group changed mean body weight. Daily inclusion of two ounces of oats appeared to facilitate reduction of serum total cholesterol and LDL-C in these hyperlipidemic individuals.

Diet, body size, and plasma lipids-lipoproteins in young adults: differences by race and sex. The Coronary Artery Risk Development in Young Adults (CARDIA) study

The Coronary Artery Risk Development in Young Adults (CARDIA) study completed baseline dietary assessment, measurement of body mass index, and lipid and lipoprotein analyses on 5,111 participants. CARDIA includes black and white men and women between 18 and 30 years of age at baseline (1985-1986), recruited in Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California. Diet was assessed by a detailed interviewer-administered diet history that measured the usual eating pattern over the past month. Possible sex, race, age, and educational differences in diet, body size, and lipids-lipoproteins were explored. Nutrient analyses indicate that the Keys score, a measure of dietary fat composition, is significantly correlated with plasma cholesterol in older (aged 25-30 years) white men (r = 0.12, p less than 0.01) and older white women (r = 0.12, p less than 0.001). In multiple linear regression analyses, body mass index was positively and significantly associated with total cholesterol and low density lipoprotein cholesterol and inversely associated with high density lipoprotein cholesterol across all race-sex groups. The Keys score was significantly associated with total cholesterol and low density lipoprotein cholesterol in white men and women. Education was associated with high density lipoprotein cholesterol in black and white women and white men. In these young adults, dietary fat intake and body mass index were related to blood lipids in certain subgroups. In black and white men and black women, blood cholesterol increased with age across race-sex groups independently of these covariates. In view of the many factors affecting plasma cholesterol and the limitations of the dietary history method, these cross-sectional data are useful in characterizing diet and lipid differences. There appears to be general disparity between recommended dietary intake of total fat, saturated fat, and other nutrients and actual dietary intake in young adults, regardless of age and educational level.